fungating facial wound

I have a pt with a large, deep fungating wound which basically encompasses the entire right side of her face (eye swollen shut for months now). There is an area of tunneling which extends from beside her nose, probably into her sinus cavity, and draining into her oral cavity. Presently the trmt is silvidene impregnated guaze packing/adaptic dressing. Of course, presently we are just trying to maintain comfort, as its a nonhealing wound. Any better ideas for dressing material? And, the pt has severe pain anytime the dressing is changed .... even with morphine prior. I remember from a wound clinic, there being an aerosol spray you could spray to the wound bed to numb the area when changing the drag or debriding the wound bed. Anybody know what that spray is ... or another which would do the same job? Thanks in advance....

its something like the numbing agent used in the perianal area after an episiotomy.

Dec 16, '12

Our pharmacy compounds a lidocaine/ acetaminophen /ketamine spray which really seems to help for many things, the main one being wounds.

Dec 16, '12

are you thinking of Dermaplast?

Dec 16, '12

I don't think its dermaplast.....this wound is deep with several areas if bone exposed. Stage IV

Dec 19, '12

Hi I saw your post.... I work in LTACHs and have seen several very challanging cranial patients get very good results with an autologous biologic. I am not sure how it could be used in regard to palliative care but I can send a study if you like... Good Luck...

Last edit by charles501 on Dec 19, '12
: Reason: spelling errors

Dec 19, '12

Yes please send to me....because I'm not familiar with it. Thanks so much!

Dec 19, '12

We often put lidocaine on the painful wound margins...

Feb 14, '13

Could you use a topical opioid? I have used these in the past with very good results.

Feb 14, '13

I did consider a topical opioid.....however, my patient is a resident of an ALF, so keeping up with a gel or spray opioid would be difficult (narcotic count). Of course, they wouldn't be able to use an injectable topically. Currently, I go daily and change dressing. Its horrible. The tunneling has basically just opened into a hole beside her nose. There's educate draining from her nose and mouth almost constantly. ... so sad. I'm using regenecare 2% lidocaine and flagyl gel (mixed) impregnated guaze to pack, covered with adaptic and foam drsg. My newest problem is the packing is sticking to good tissue...making it a tedious task to remove...even with NS. IMits very painful too. I ordered hurricane spray to use when removing old packing but I'm scared to use thinking it wk born and cause more pain. The packing isn't drying out...don't know why it's sticking so bad....any ideas?

Feb 14, '13

We use something called mepitel which is I believe an inert silicone-type material that is kind of like a post-it note in that it stays where you put it but is easy to remove. Use it directly on the wound bed with the packing material on top. Helps keep other dressings from sticking to the wound and you don't have to remove it each time the dressing is changed. It has holes in it that let exudate out and saline in for cleansing. Something like that might help with the problem of dressings adhering to the wound bed.

Feb 14, '13

Oh my gosh, poor lady, must be so awful for her What about using some Vaseline gauze? i had the exact same problem with a fungating wound on a leg recently, and it was causing it to bleed when removing dressings, this worked fantastic and the dressings just came off very easily with no discomfort for the patient.

Feb 14, '13

isn't adaptic basically a vaseline-type guaze?

i have worked on many fungating wounds and no matter what product is used, it remains incredibly painful.
i have found that working as quickly as humanly possible, was the kindest thing we could do for these patients.

dang, i recall a cn who would take her sweet time when changing these dsgs.
the grimaces, clenched teeth, moaning was too much for ME to bear and i ended up snapping at her:
"can you pick up the pace, harriet?"

seriously, i do believe that knowing these wounds won't heal and that our goals are to prevent infection or secondary complications...
that just pretty much changing dsg at speed of light, will benefit pt the most...imo.
and yes, premedicating (with anxiolytic as well!) is critical, too.